Foot Progression Angle in Individuals with Diabetes & Peripheral Neuropathy

糖尿病患者的足部进展角度

• 批准号: 8551382
• 负责人: Ericka Nayram Merriwether
• 金额: $ 2.68万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-05-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8551382
• 关键词: 10p; Accounting; Adult; Amputation; Ankle; Area; Articular Range of Motion; Characteristics; Child; Clinical; Cross-Sectional Studies; Cues; Development; Diabetes Mellitus; Early Intervention; Foot Ulcer; Foot joint structure; Gait; Hip Joint; Hip region structure; Impairment; Individual; Instruction; Intervention; Investigation; Joints; Knowledge; Lead; Left; Lower Extremity; Measures; Medial; Methods; Modification; Motion; Movement; Muscle; Neuropathy; Outcome; Participant; Performance; Peripheral Nervous System Diseases; Phase; Plantar Ulcers; Proxy; Recording of previous events; Rehabilitation therapy; Research; Research Design; Risk; Risk Factors; Rotation; Secondary to; Severities; Severity of illness; Skin; Time; Ulcer; United States; Visual; ankle joint; clinically significant; cost effective; effective intervention; foot; high risk; improved; indexing; instrument; interest; neurological pathology; pressure; treatment site

DESCRIPTION (provided by applicant): The long-term objective of this research is to determine the contribution of foot progression angle (FPA), a spatial gait variable that represents foot rotation in the transverse plane, to the development of neuropathic plantar ulcers in adults with diabetes mellitus and peripheral neuropathy (DMPN). Clinical Significance: There are approximately 80,000 non-traumatic lower extremity amputations annually in the United States, 84% of which are preceded by neuropathic plantar ulcers. Adults with DMPN are at high risk for neuropathic plantar ulceration secondary to increased peak plantar pressure under bony prominences on an insensate foot. Therefore, peak plantar pressure is frequently used as a proxy measure of risk for skin breakdown and subsequent non-traumatic lower extremity amputation. Preliminary studies suggest a direct relationship between excessive external FPA and the timing and magnitude of medial peak plantar pressure in children with neurological pathology and in adults with DMPN. Given that adults with DMPN have nearly three times the rate of functional mobility deficits associated with lower extremity impairment than their healthy counterparts, it is imperative to improve our understanding of the contribution of excessive external FPA to the impairment cascade of excessive medial peak plantar pressures, medial neuropathic plantar ulceration, and non-traumatic lower extremity amputation. Unexplored areas of research: Despite the strong relationship between excessive external FPA and plantar pressure, to our knowledge there are no studies that have examined joint mobility limitations that contribute to FPA in individuals with DMPN. Furthermore, there are no studies probing whether excessive external FPA can be reduced in adults with DMPN, thereby creating a potential strategy for early rehabilitation intervention in the non-traumatic lower extremity amputation impairment cascade. Our proposed research seeks to improve understanding of specific movement impairments that contribute to increased external FPA magnitude in adults with DMPN, and if those impairments are amenable to early intervention. Aim 1: Determine the characteristics of FPA in groups of subjects with diabetes mellitus without peripheral neuropathy (DM only), without diabetes mellitus (CON), with diabetes mellitus and peripheral neuropathy WITH a history of neuropathic plantar ulcers (DMPN [+] NPU), and with diabetes mellitus and peripheral neuropathy WITHOUT a history of neuropathic plantar ulcers (DMPN [-] NPU). Aim 2: Determine ability of select lower extremity joint variables to predict FPA magnitude; Aim 3: Determine the effect of reducing FPA on medial peak plantar pressure in individuals with diabetes with excessive FPA magnitude. Expected outcomes: We hypothesize that foot, ankle, and hip joint motion limitations contribute substantially to excessive external FPA magnitude in adults with DMPN. We also hypothesize that after instruction, participants with DMPN can intentionally reduce their FPA, resulting in concomitant decreases in medial peak plantar pressure.

描述（由申请方提供）：本研究的长期目标是确定足部前进角（FPA）（一种代表足部在横向平面内旋转的空间步态变量）对糖尿病和周围神经病变（DMPN）成人神经性足底溃疡发展的影响。临床意义：在美国，每年约有80，000例非创伤性下肢截肢，其中84%在神经性足底溃疡之前。患有DMPN的成年人患神经性足底溃疡的风险很高，继发于无感觉足上骨压迫下足底峰值压力增加。因此，足底压力峰值经常被用作皮肤破裂和随后的非创伤性下肢截肢风险的替代指标。初步研究表明，过度的外部FPA与神经病理学儿童和DMPN成人的内侧峰值足底压力的时间和幅度之间存在直接关系。鉴于DMPN成人与下肢损伤相关的功能性活动缺陷的发生率几乎是健康成人的三倍，因此必须提高我们对过度外部FPA对过度内侧峰值足底压力、内侧神经性足底溃疡和非创伤性下肢截肢的损伤级联的贡献的理解。未探索的研究领域：尽管过度的外部FPA和足底压力之间有很强的关系，据我们所知，没有研究已经检查了关节活动性限制，有助于FPA在个人与DMPN。此外，还没有研究探讨是否可以减少DMPN成人的过度外部FPA，从而为非创伤性下肢截肢损伤级联的早期康复干预创造一个潜在的策略。我们提出的研究旨在提高对特定运动障碍的理解，这些运动障碍有助于DMPN成人的外部FPA幅度增加，以及这些障碍是否适合早期干预。目标1：确定糖尿病无周围神经病变（仅DM）、无糖尿病（CON）、糖尿病伴周围神经病变伴神经病性足底溃疡病史（DMPN [+] NPU）和糖尿病伴周围神经病变无神经病性足底溃疡病史（DMPN [-] NPU）受试者组的FPA特征。目标二：确定选择下肢关节变量预测FPA幅度的能力;目的3：确定降低FPA对FPA幅度过大的糖尿病患者内侧峰值足底压力的影响。预期成果：我们假设，足，踝关节和髋关节运动的限制，大大有助于过度的外部FPA幅度在成年人DMPN。我们还假设，在指导后，DMPN的参与者可以故意降低他们的FPA，导致足底内侧峰值压力随之降低。